Pruritic papular eruption of HIV

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Background

  • Most common rash of HIV[1]
  • Presenting symptom of HIV in up to ~80% cases
  • 3x more common when CD4 count < 200
  • Up to 46% of HIV patients have this rash at some time of disease course
  • Diagnosis of exclusion

Clinical Features

Intensely pruritic papular rash with greatest severity on the extensor surfaces of extremities.
Pruritic papular eruptions as presenting illness of HIV.
Pruritic papular lesions on hands.
  • Pruritic
  • Diffusely, symmetrically distributed rash
    • Discrete red bumps initially
    • Extremities/trunk > face
    • Mucous membrane sparing

Differential Diagnosis

HIV associated conditions

Evaluation

  • Appropriate clinical setting

Management

Disposition

  • Outpatient dermatology follow up
  • Average time for recurrence of skin condition ~8 wks

References

  1. Cutaneous manifestations of HIV in the era of highly active antiretroviral therapy: an institutional urban clinic experience. Zancanaro PC et al. J Am Acad Dermatol. 2006 Apr;54(4):581-8.
  2. Gutteridge, David L MD, MPH, Egan, Daniel J. MD. The HIV-Infected Adult Patient in The Emergency Department: The Changing Landscape of the Disease. Emergency Medicine Practice: An Evidence-Based Approach to Emergency Medicine. Vol 18, Num 2. Feb 2016.
  3. Maurer. Dermatologic Manifestations of HIV Infection. Perspective – Dermatologic Manifestations Volume 13 Issue 5 December 2005/January 2006.